The majority of our correctional patients are still fairly young. Many of the youthful (and not-so-youthful) incarcerated individuals spend their available time in sports and bodybuilding activities. These individuals are prone to contracting exertional rhabdomyolysis (“Rhabdo”). Correctional nurses need to be alert to this potential health problem and respond timely and appropriately to deter a potentially fatal outcome.
What Causes Exertional Rhabdomyolysis?
Rhabdomyolysis is the breakdown of muscle tissue that then causes an outpouring of intercellular contents including myoglobin, potassium, and creatine kinase (CK). These three elements cause the life-threatening effects of the condition. Non-traumatic rhabdomyolysis can be caused by severe over-exercise, major drug ingestion, or as a result of statin use. Many corrections-related incidents of rhabdomyolysis appear in the literature including 110 knee-bends performed as a part of an inmate hazing event, narcotic overdose and intravenous drug use.
Rhabdomyolysis can start innocuously and may be overlooked as delayed onset muscle soreness from over-exertion. Symptoms may be generalized and could be related to a number of different benign conditions. Thus, it is important to follow-up with any patient who complains of these symptoms to ensure that they are improving. However, if the overly sore muscles are accompanied by dark/brown urine (described often as peeing “coca-cola”) or urine irregularities such as nocturia or anuria, beware. Further assessment is warranted.
A good history and assessment is necessary, including any unusual activities over the last 48 hours and a medication review. Many of our patient population are now on statins, which can complicate exertional rhabdomyolysis. If rhabdomyolysis is suspected, expect that there will be a provider order for laboratory studies for CK, potassium, and myoglobin that should be drawn. The patient’s urine output and cardiac rhythm should be monitored. Per provider order, fluids should be administered to assist the body to flush out the muscle breakdown byproducts. If not caught early enough, renal dialysis and/or cardiac interventions may be necessary.
Patient and Officer Education
One of the most important nursing interventions for rhabdomyolysis is patient and officer education. All bodybuilders should be aware that brown urine is a bad sign that should lead to a medical visit request. Officers should understand the adverse effects of hazing activities that might be a part of a particular facility’s culture and should work to eliminate any such activities. Our patient population can fall prey to competitive weightlifting challenges that go beyond rational sense, requiring intervention. Prevention or early detection and treatment of rhabdomyolysis can help the incarcerated patient avoid renal failure and life-threatening arrhythmias.
With awareness, education and vigilance, correctional nurses can reduce the chances that their patients will suffer from the potentially life-threatening results of rhabdomyolysis.
Have you experienced a rhabdomyolysis incident at your facility? Please share your experience in the comments section of this post.